超微血流成像对糖尿病足横向骨搬移治疗后下肢动脉血流动力学的监测价值研究

Superb microvascular imaging to monitor hemodynamic changes in lower limb arteries in treatment of diabetic foot by tibial transverse transport

目的利用超微血流成像技术观察横向骨搬移过程中糖尿病足下肢动脉血流动力学的变化, 探讨该技术在横向骨搬移中的应用价值。方法回顾性分析自2019年12月至2021年12月山西医科大学第二医院骨科采用横向骨搬移治疗的17例糖尿病足患者资料。选用超微血流成像模式观察患者术前、术后1周、术后1个月第1跖背动脉血管指数、胫前动脉和胫后动脉总血流量和Wagner分级情况。并记录并发症发生情况。结果 17例患者在接受治疗后手术同侧与对侧均探及新生血管。末次随访时新生侧支数量为7.0(3.5, 9.0)支, 与术前的1.0(0, 1.5)支相比, 差异有统计学意义(P<0.05)。与术前第1跖背动脉血管指数(5.65±4.36)相比, 术后1周(9.70±10.88)和术后1个月(9.22±5.46)增大, 差异均有统计学意义(P<0.05)。术前、术后1周、术后1个月胫前动脉和胫后动脉总血流量相比差异无统计学意义(P>0.05)。术后1个月Wagner分级(1级4例, 2级11例, 3级2例)较术前(2级1例, 3级2例, 4级14例)、术后1周(2级1例, 3级5例, 1级11例)改善, 差异均有统计学意义(P<0.05)。1例患者因术后2个月发生急性下肢动脉栓塞而行截肢, 1例因足趾发黑而行截趾。结论超微血流成像技术监测客观反映了横向搬移后血流动力学及微循环的变化情况, 为病情的预后提供了有价值的信息, 并确定了骨搬移过程中影像学的监测价值。

Objective To evaluate superb microvascular imaging used to monitor the hemodynamic changes in lower limb arteries in the treatment of diabetic foot by tibial transverse transport.Methods From December 2019 to December 2021,17 patients with diabetic foot were treated by tibial transverse transport at Department of Orthopedics,The Second Hospital of Shanxi Medical University.Superb microvascular imaging was used to observe the vascular index of the first dorsal metatarsal artery,the total blood flow of the anterior tibial artery and the posterior tibial artery,and the Wagner classification in the patients before surgery,one week and one month after surgery.Complications were documented.Results After treatment,neovascularization was observed in all the 17 patients and detected on both the ipsilateral and contralateral sides of the surgery.At the last follow-up,the number of newborn collaterals was 7.0(3.5,9.0),significantly larger than that before surgery[1.0(0,1.5)](P<0.05).The vascular index of the first dorsal metatarsal artery at one week(9.70±10.88)and one month(9.22±5.46)after surgery was significantly higher than that before surgery(5.65±4.36)(P<0.05).There was no significant difference in the total blood flow between the anterior tibial artery and the posterior tibial artery before surgery,one week or one month after surgery(P>0.05).The Wagner classification at one month after surgery(grade 1 in 4,grade 2 in 11 and grade 3 in 2)was significantly better than that before surgery(grade 2 in one,grade 3 in 2 and grade 4 in 14)and one week after surgery(grade 2 in one,grade 3 in 5 and grade 1 in 11)(P<0.05).One patient underwent amputation due to acute lower extremity arterial embolism 2 months after operation,and another patient underwent toe amputation due to blackening of the toes.Conclusion Superb microvascular imaging is a valuable means of monitoring in tibial transverse transport because it can objectively reflect the hemodynamic changes and microcirculation in lower limb arteries and provide valuable information for prognosis of the condition in the treatment of diabetic foot by tibial transverse transport.